Mohs Micrographic Surgery (MMS) reimbursement
Defines UnitedHealthcare Medicare Advantage reimbursement rules for reporting Mohs micrographic surgery (CPT 17311-17315), including when pathology is inclusive or separately billable, modifier guidance, and multiple procedure reduction treatment. Applies to providers submitting CMS-1500 claims to UnitedHealthcare Medicare Advantage.
No material clinical or coverage changes in this revision.
Coverage and Billing Rules for Mohs Micrographic Surgery
(untitled)
Covered when ALL of the following billing and documentation rules are met:
ALL of the following
- Mohs micrographic surgery is performed as a two-step process: the tumor is removed in stages with immediate histologic evaluation of margins, and additional excision and evaluation are performed until all margins are clear.
Operational definition of Mohs technique.
- A single physician must perform both the surgical and the pathologic examination functions for Mohs (i.e., the Mohs surgeon must also perform the microscopic examination).
Per AMA and NCCI guidance; Mohs CPT codes 17311-17315 represent integrated surgeon+pathologist roles.
- Mohs CPT codes 17311-17315 should NOT be reported if the surgeon delegates either the surgical or pathology responsibilities to another physician or qualified health professional who reports those services separately; in such cases the Mohs codes will be denied.
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